04520 (SFD)w 04520
- P.O. BOX 1504
Building, 55-889 Pinehurst 78-105 CALLE ESTADO
Address. LA QUINTA, CALIFORNIA 92253
Owner.-
. , Company
Mailing BUILDING: "TYPE CONST. OCC. GRP.
Address 75-005 Country Club Dative A.P. Number MA Wear — The Plairwa n
City ,.Zip Tel. -
FaLT0Decor 32260 568--8213 - Legal Description
Contractor
Project Description P'Lax!. PA
Address
• ��IRFl�
City
Zip
Tel.
State Lic.
& Classif. 188130
City
Lic. # 398.
Sq. Ft. 3038
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
.SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby, affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or County which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requirestheapplicant, for such permit to file a signed statement that he is licensed pursuant to
the provisloris� Vthe,Contraclor's License Law, Chapter 9 (commencing with Section 7000) of
Division;'3'.ol;Me'Buslness and Professions Code, or that. he is exempt therefrom, and the basis
for tpe`�allegedleicemption. Any violation of Section 7031.5 by any applicant for a permit
subjeots fhe',appllcanl.t , a•cfvil penalty of not more than five hundred dollars ($500).
as owner of;tfte'property, or my employees with wages as their sole compensation, will
do the vrork,`anii Ilia structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code:'The Contractor's License Law does not apply to an owner of property who
Estimated Valuation
�+�^� ��
I'7 1
PERMIT
'
AMOUNT
Plan Chk. Dep.
Plan Chk. BBI.
cC'
vq�e eV
X49
Const.♦
g r
728,00
e'�i
Mech.
tt^7i
39,00
builds -.or: Improves thereon and who does such work himself or through his own employees.
provided,'Jhat'suchIimprovements are not intended or offered for sale. If, however, the building
or improvement,is'sold- within one year of completion, the owner -builder will have the burden
ol.proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
structsthe project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec. B. & P.C. for this reason
Electrical
109.94
Plumbing
118.00
S.M.I.
15.26
Grading
Driveway Enc.
Dale. Owner
Infrastructure
OSr. e.01t
Zf,%4 .J
WORKERS' COMPENSATION DECLARATION
Not Intrauttlicture
2,443.55
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy NO. Company
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
1
TOTAL
1514, (J:1..UI "I.:r''.411- C/
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
REMARKS
SY'r -✓lv' jt� "i$`F'tb��:fa "S'% -r �+ t j�
-
Date Owner
NOTICE TO APPLICANT: If after making this Certificate of Exemption you should become
subject to. the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, civil code.)
Side Setback from Property Line
Lender's Name
FINAL DATE
T
INSPEqCOR
8/1 / i O
// 89
Lender's Address
This Is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I'car tify that I have read this application and state that the above Information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
Cit;; State, Zip
WHITE FINANCE PINK APPLICANT GREEN BUILDING, GOLDENROD ASSESSORS OFFICE, HARD COPY - FILE
..-��:.r _ . h.'i ._Lea '... �. 'ta f ... ,, x L.. ..c1.a;L.s. ,w. r, y.:u. s t.. ,-.a _ �::Lr. .MA's.h'+ !"Xk 'i:=_-�Y �S n. _... ,.. _ s: :_. wri•rr.^ �, _.wF:.'N.il.r. .. y. � .. �'1}., w.. ._ :l.C.. .. .. .. ..� ,.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl. (p S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING -
MOBILEHOME SVC.
BAR SINK
POR SO FTa
GAS (ROUGH)
METER LOOP
GAR SO. FT. (a
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. 50 FT. (a
GROUT
WATER HEATER
WALL SO. FT. (a
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. fa
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
• NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. c
BATH TUB
LATHING
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.'
SO. FT. RESID (it I 1 c
SEWAGE DISPOSAL
SO.FT.GAR ar 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE . . . PLUMBING I ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE -TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING -
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL :d